Provider Demographics
NPI:1649349101
Name:KORNEGAY, DONNA CHANDLER (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:CHANDLER
Last Name:KORNEGAY
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 SOUTHPARK DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7738
Mailing Address - Country:US
Mailing Address - Phone:919-949-5280
Mailing Address - Fax:919-361-1900
Practice Address - Street 1:5011 SOUTHPARK DR
Practice Address - Street 2:SUITE 130
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7738
Practice Address - Country:US
Practice Address - Phone:919-949-5280
Practice Address - Fax:919-361-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1405FOtherBCBS
NC2301466OtherCIGNA
NC6102847Medicaid